Rasmussen University NUR 2243 Module 8 (pdf) | 2026/2027 | Prof
Nursing Skills I Q&A | Nursing
1. Which of the following best describes the difference between preload and
afterload?
A) Preload is the resistance the ventricle must overcome to eject blood, while
afterload is the volume of blood in the ventricles at the end of diastole
B) Preload is the volume of blood in the ventricles at the end of diastole,
while afterload is the resistance the ventricle must overcome to eject blood
C) Preload is the pressure in the arteries during systole, while afterload is the
pressure during diastole
D) Preload and afterload are two terms that describe the same physiological
process
Correct Answer: Preload is the volume of blood in the ventricles at the end of
diastole, while afterload is the resistance the ventricle must overcome to
eject blood
Rationale: Preload refers to the volume of blood in the ventricles at the end
of diastole, representing the degree of stretch of the cardiac muscle fibers.
Afterload is the pressure or resistance that the ventricles must overcome to
eject blood through the semilunar valves. Increased afterload, as seen in
hypertension, increases cardiac workload.
2. A client with heart failure is being assessed. The nurse understands that a
sudden weight gain of 2.2 lbs (1 kg) is most likely indicative of:
A) Muscle gain from improved nutrition
B) Excess fluid retention in the interstitial spaces
C) The client is wearing heavier clothing
D) A normal daily fluctuation in weight
Correct Answer: Excess fluid retention in the interstitial spaces
,Rationale: A sudden weight gain of 2.2 lbs (1 kg) can result from excess fluid
(1 L) in the interstitial spaces. Daily weight is the best indicator of fluid
balance, and it is possible for weight gains of up to 10 to 15 lbs to occur
before edema is apparent.
3. A client has a myocardial infarction. The nurse should monitor which
laboratory value as the most specific indicator of myocardial injury?
A) Creatine kinase (CK)
B) Cardiac troponin
C) Lactate dehydrogenase (LDH)
D) Myoglobin
Correct Answer: Cardiac troponin
Rationale: Cardiac troponin is a myocardial muscle protein released into the
bloodstream with injury to myocardial muscle. Troponins T and I are not
found in healthy patients; any rise in values indicates cardiac necrosis or
acute MI. Troponin I levels greater than 0.03 ng/mL indicate myocardial
injury.
4. A client presents with crushing chest pain, diaphoresis, and nausea. The
12-lead ECG shows ST-segment elevation in multiple leads. The nurse should
prepare the client for which type of intervention?
A) Administration of thrombolytics or percutaneous coronary intervention
(PCI)
B) Administration of oral antiplatelet agents only
C) Immediate transfer to a medical-surgical unit
D) Administration of a beta-blocker and discharge home
,Correct Answer: Administration of thrombolytics or percutaneous coronary
intervention (PCI)
Rationale: ST-segment elevation MI (STEMI) indicates a 100% blockage of a
coronary artery and is a medical emergency. Immediate reperfusion therapy
with thrombolytics or percutaneous coronary intervention (PCI) is the priority
to restore blood flow and limit myocardial damage.
5. A nurse is caring for a client who is in ventricular fibrillation (VF). Which
action should the nurse take first?
A) Administer amiodarone
B) Perform defibrillation
C) Start CPR
D) Prepare for synchronized cardioversion
Correct Answer: Perform defibrillation
Rationale: Ventricular fibrillation is a shockable, chaotic rhythm with no
cardiac output or pulse. The priority treatment is immediate defibrillation.
Ventricular fibrillation is fatal if not resolved within 3-5 minutes.
6. A client is in pulseless electrical activity (PEA). Which action should the
nurse take?
A) Perform defibrillation
B) Administer amiodarone
C) Start high-quality CPR and identify reversible causes
D) Perform synchronized cardioversion
Correct Answer: Start high-quality CPR and identify reversible causes
, Rationale: Pulseless electrical activity (PEA) is a condition where there is
electrical activity on the monitor but no palpable pulse. The priority is to
start high-quality CPR and identify and treat reversible causes (the "H's and
T's"). Defibrillation is not indicated for PEA.
7. A client is in asystole. Which of the following is the appropriate nursing
action?
A) Defibrillate immediately
B) Administer epinephrine
C) Start CPR and assess for reversible causes
D) Perform synchronized cardioversion
Correct Answer: Start CPR and assess for reversible causes
Rationale: Asystole is a "flatline" rhythm with no cardiac electrical activity.
The priority is to start high-quality CPR and identify and treat reversible
causes. Defibrillation is not indicated for asystole.
8. A nurse is assessing a client with chest pain. Which characteristic of the
pain is most indicative of a myocardial infarction rather than stable angina?
A) Pain is relieved by rest
B) Pain is relieved by sublingual nitroglycerin
C) Pain is not relieved by rest or nitroglycerin
D) Pain is described as a sharp, stabbing sensation
Correct Answer: Pain is not relieved by rest or nitroglycerin
Nursing Skills I Q&A | Nursing
1. Which of the following best describes the difference between preload and
afterload?
A) Preload is the resistance the ventricle must overcome to eject blood, while
afterload is the volume of blood in the ventricles at the end of diastole
B) Preload is the volume of blood in the ventricles at the end of diastole,
while afterload is the resistance the ventricle must overcome to eject blood
C) Preload is the pressure in the arteries during systole, while afterload is the
pressure during diastole
D) Preload and afterload are two terms that describe the same physiological
process
Correct Answer: Preload is the volume of blood in the ventricles at the end of
diastole, while afterload is the resistance the ventricle must overcome to
eject blood
Rationale: Preload refers to the volume of blood in the ventricles at the end
of diastole, representing the degree of stretch of the cardiac muscle fibers.
Afterload is the pressure or resistance that the ventricles must overcome to
eject blood through the semilunar valves. Increased afterload, as seen in
hypertension, increases cardiac workload.
2. A client with heart failure is being assessed. The nurse understands that a
sudden weight gain of 2.2 lbs (1 kg) is most likely indicative of:
A) Muscle gain from improved nutrition
B) Excess fluid retention in the interstitial spaces
C) The client is wearing heavier clothing
D) A normal daily fluctuation in weight
Correct Answer: Excess fluid retention in the interstitial spaces
,Rationale: A sudden weight gain of 2.2 lbs (1 kg) can result from excess fluid
(1 L) in the interstitial spaces. Daily weight is the best indicator of fluid
balance, and it is possible for weight gains of up to 10 to 15 lbs to occur
before edema is apparent.
3. A client has a myocardial infarction. The nurse should monitor which
laboratory value as the most specific indicator of myocardial injury?
A) Creatine kinase (CK)
B) Cardiac troponin
C) Lactate dehydrogenase (LDH)
D) Myoglobin
Correct Answer: Cardiac troponin
Rationale: Cardiac troponin is a myocardial muscle protein released into the
bloodstream with injury to myocardial muscle. Troponins T and I are not
found in healthy patients; any rise in values indicates cardiac necrosis or
acute MI. Troponin I levels greater than 0.03 ng/mL indicate myocardial
injury.
4. A client presents with crushing chest pain, diaphoresis, and nausea. The
12-lead ECG shows ST-segment elevation in multiple leads. The nurse should
prepare the client for which type of intervention?
A) Administration of thrombolytics or percutaneous coronary intervention
(PCI)
B) Administration of oral antiplatelet agents only
C) Immediate transfer to a medical-surgical unit
D) Administration of a beta-blocker and discharge home
,Correct Answer: Administration of thrombolytics or percutaneous coronary
intervention (PCI)
Rationale: ST-segment elevation MI (STEMI) indicates a 100% blockage of a
coronary artery and is a medical emergency. Immediate reperfusion therapy
with thrombolytics or percutaneous coronary intervention (PCI) is the priority
to restore blood flow and limit myocardial damage.
5. A nurse is caring for a client who is in ventricular fibrillation (VF). Which
action should the nurse take first?
A) Administer amiodarone
B) Perform defibrillation
C) Start CPR
D) Prepare for synchronized cardioversion
Correct Answer: Perform defibrillation
Rationale: Ventricular fibrillation is a shockable, chaotic rhythm with no
cardiac output or pulse. The priority treatment is immediate defibrillation.
Ventricular fibrillation is fatal if not resolved within 3-5 minutes.
6. A client is in pulseless electrical activity (PEA). Which action should the
nurse take?
A) Perform defibrillation
B) Administer amiodarone
C) Start high-quality CPR and identify reversible causes
D) Perform synchronized cardioversion
Correct Answer: Start high-quality CPR and identify reversible causes
, Rationale: Pulseless electrical activity (PEA) is a condition where there is
electrical activity on the monitor but no palpable pulse. The priority is to
start high-quality CPR and identify and treat reversible causes (the "H's and
T's"). Defibrillation is not indicated for PEA.
7. A client is in asystole. Which of the following is the appropriate nursing
action?
A) Defibrillate immediately
B) Administer epinephrine
C) Start CPR and assess for reversible causes
D) Perform synchronized cardioversion
Correct Answer: Start CPR and assess for reversible causes
Rationale: Asystole is a "flatline" rhythm with no cardiac electrical activity.
The priority is to start high-quality CPR and identify and treat reversible
causes. Defibrillation is not indicated for asystole.
8. A nurse is assessing a client with chest pain. Which characteristic of the
pain is most indicative of a myocardial infarction rather than stable angina?
A) Pain is relieved by rest
B) Pain is relieved by sublingual nitroglycerin
C) Pain is not relieved by rest or nitroglycerin
D) Pain is described as a sharp, stabbing sensation
Correct Answer: Pain is not relieved by rest or nitroglycerin
